The Changing Faces of the Doctors

The results of the 2014 Survey of America’s Physicians: Practice Patterns and Perspectives was recently released by The Physicians Foundation.

Some of the key findings of the survey can be confusing unless we examine the changing demographics and employment status of doctors and ask how those demographic changes relate to doctor morale.

On the one hand doctors feel busier than ever before and they believe their autonomy is under attack. According to the survey:

“81% of physicians describe themselves as either overextended or at full capacity, up from 75%in 2012 and 76% in 2008. Only 19% say they have time to see more patients.” “69% of physicians believe that their clinical autonomy is sometimes or often limited and their decisions compromised.”

On the other hand, the overall morale, by some measures, has improved from 2012:

“44% of physicians describe their morale and their feelings about the current state of the medical profession as positive, an increase from 32% in 2012.”

“29% of physicians would not choose medicine if they had their careers to do over, a decrease from 35% in 2012.”

To understand these numbers we have to look at what the report calls the New Guard in medicine. In short the New Guard doctors tend to be primary care physicians, they tend to be more female, and they tend to be younger. Interestingly, the primary care doctors and women doctors tend to have a more positive view of medicine than their specialist and male colleagues.

The New Guard:

The 2014 Survey of America’s Physicians: Practice Patterns and Perspectives introduces the idea of the New Guard of Doctors. What does this new Guard Look like?

More Primary Care…

One major change documented in the survey seems to be the transition from specialist to primary care medicine. 37% of respondents in the 2014 survey identified as primary care whereas 34.8% did in 2012. The authors of the report note the comparable positive outlook of primary care doctors might account for the overall rise in doctor morale from 2012.

The report explains:

“The increased participation of primary care physicians in the 2014 survey and their relatively positive perspective compared to specialists reflects this shift from a medical profession that once was largely driven by specialty doctors to one in which primary care physicians are experiencing rising influence.”(p. 40)

More Women…

The trend toward a greater percentage of female doctors continues.   33% of the respondents were woman in 2014 compared to 26% in 2012. (p. 40) Furthermore 50% of medical students are currently female (p. 41) and the percentage of women in primary care specialties tends to be greater. Women tend to have a more positive view of medicine than men and this too might have affected the overall morale rate of the survey.

Older, but soon younger…

42% of the doctor population is 55 or older. (p. 41) But the changing of the guard is imminent :

“Medicine soon will be faced with a wave of physician retirements as baby boom doctors begin to exit the field. … The younger physicians who take their place are likely to have different attitudes toward medicine and the healthcare system as a whole, and, in fact, both the 2012 and 2014 surveys indicate they have a relatively more positive perspective than do older physicians.” (p. 41)

Employed…

In the 2012 survey, 44% of doctors responded that they were employed, and in the 2014 survey that number rose to 53% (p. 42) 90% of newly hired doctors are choosing employment over private practice or partnerships. (p. 42)

Today, more doctors are employed (salaried) doctors than ever before and it appears that this trend will not only continue but also grow.

The trend toward employment status ties closely toward medicine other trends toward primary care, woman, and younger doctors.

Employed Physicians by Type: (p. 42)

45 or <	65.7%
46 or >	25.7%
Female	58.5%
Male	50.1%
Primary Care	58.2%
Specialist	49.9%

What is important to doctors?

But perhaps the biggest question is the extent to which the changing demographics and employment status of doctors affects the meaning of morale and job satisfaction. In short, are the major issues and concerns of the salaried doctors today the same as the self-employed doctor in the past? Does the survey, which tracked questions of morale since doctors were predominately self employed and male, correctly understand the key issues for today’s primary care women doctors?

In one of the classic questions that measures physicians’ morale, namely would you recommend medicine as a career to your children, 50% of physicians said they would in 2014 as compared to 42% in 2012 and 40% in 2008. (p. 9) But what is this question measuring? Would a self-employed male specialist in 2008 even use the same criteria in answering about morale as a primary care salaried woman physician in 2014?

In the next blog we will look deeper into the morale numbers in the survey and try to understand what today’s doctors are fighting for and how questions of morale and satisfaction are changing.